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ClinicalTrials.gov Id: NCT00487851
Study Title: Comparing Endoscopic Based Stent Strategy
Versus Bypass Surgery in Non-resectable Periampullary
Cancer
First Received: June 18, 2007
Last Updated: June 22, 2011

Twenty-one trials involving 1,454 people were included.

Based on meta-analysis,
Endoscopic plastic stents associated with a reduced risk of complications (RR
0.60, 95% CI 0.45 - 0.81), but with higher risk of recurrent biliary obstruction
prior to death (RR 18.59, 95% CI 5.33 - 64.86) when compared with surgery.
There was a trend towards higher 30-day mortality in the surgical group
(p=0.07, RR 0.58, 95% CI 0.32, 1.04).
There was no evidence of a difference in technical or therapeutic success. In
endoscopic stent comparisons, metal biliary stents appear to have a lower
risk of recurrent biliary obstruction than plastic stents (RR 0.52, 95% CI 0.39 0.69). There was no significant statistical difference in technical success,
therapeutic success, complications or 30-day mortality using meta-analysis.

Endoscopic metal stents are the intervention of choice at present in

patients with malignant distal obstructive jaundice due to pancreatic
carcinoma. In patients with short predicted survival, their patency
benefits over plastic stents may not be realised.
Cochrane Database Syst Rev. 2006Apr19;(2):CD004200. Palliative
biliary stents for obstructing pancreatic carcinoma. Moss
AC, Morris E, Mac Mathuna P.


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Summarizes early mortality in relation to liver

functional reserve (A) and early survival in
relation to treatment (B).
A: Early overall mortality related to Child
status;
B: Early survival related to type of treatment.

Management of ruptured hepatocellular carcinoma: Implications for

therapy./Nicol Bassi at all./World J Gastroenterol. 2010 March
14; 16(10): 12211225.Published online 2010 March


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Management of ruptured hepatocellular carcinoma: Implications for

therapy./Nicol Bassi at all./World J Gastroenterol. 2010 March
14; 16(10): 12211225.Published online 2010 March

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